YesObjective\ud \ud This study explores whether the profile of patients’ interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases.\ud \ud Methods\ud \ud Conversation Analysis of video recordings of neurologists’ interactions with patients attending a specialist memory clinic. “Gold standard” diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging.\ud \ud Results\ud \ud Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients’ responses to neurologists’ questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent “I don’t know” responses.\ud \ud Conclusion\ud \ud Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD.\ud \ud Practical implications\ud \ud Our findings demonstrate that conversational profiles based on patients’ contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care

Objectives: In the UK dementia is under-diagnosed and there is national variation in memory clinic service provision. At present the clinical differentiation between dementia and functional (nonprogressive) memory complaints is complex and involves extensive neuropsychological testing. Government initiatives on 'timely diagnosis' aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve methods of diagnostic screening by analysing communication between clinicians and patients during diagnostic assessment and establishing conversational profiles from which clinicians can establish differential diagnoses.Method: The data corpus consists of video-and audio recording of 105 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used explore recurrent communicative practices within these data.Results: Two discrete conversational profiles began to emerge to help differentiate between patients with dementia and functional memory complaints based on, 1) whether the patient is able to answer questions about personal information; 2) whether they can display working memory in interaction; 3) whether they are able to respond to compound questions; 4) the time taken to respond to questions; and 5) the level of detail they offer when providing an account of their memory failure experiences.Conclusion: Conversational profiles can differentiate patients with dementia from those with functional memory complaints. Conversational profiling has potential clinical application; using conversation as a method of diagnostic screening and assessment could hold differential diagnostic value.

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This study indicates that interactional and linguistic features can help distinguish between patients developing dementia and those with FMD and could aid the stratification of patients with memory problems.

The Addenbrooke’s Cognitive Examination (ACE-111) is a neuropsychological test used in clinical practice to inform a dementia diagnosis. The ACE-111 relies on standardized administration so that patients’ scores can be interpreted by comparison with normative scores. The test is delivered and responded to in interaction between clinicians and patients, which places talk-in-interaction at the heart of its administration. In this article, conversation analysis (CA) is used to investigate how the ACE-111 is delivered in clinical practice. Based on analysis of 40 video/audio-recorded memory clinic consultations in which the ACE-111 was used, we have found that administrative standardization is rarely achieved in practice. There was evidence of both (a) interactional variation in the way the clinicians introduce the test and (b) interactional non-standardization during its implementation. We show that variation and interactional non-standardization have implications for patients’ understanding and how they might respond to particular questions.